mesenchymal tumors

8/3/2019 Mesenchymal Tumors

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Mesenchymal

TumorsGroup II DFDCelso, Chalaki, Concepcion, Derakshanfard


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Odontogenic Myxoma

an uncommon benignodontogenic tumor arising

from embryonic connective

tissue associated with tooth

formation

This is a benign neoplasm

that may be infiltrative and

aggressive


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Odontogenic Myxoma

Clinical FeaturesMean age of occurrence is 30 years old

With no gender predilection

Lesions may be seen in either jaws

Mandible 63% Maxilla 37%


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Odontogenic Myxoma

In the maxilla: it can be found anywhere inthe maxilla and constantly involve the

maxillary sinus


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Odontogenic Myxoma

In the mandible: lesions aregenerally found in the molar and

premolar region. Which may

extend to the ascending ramus

and the condylar region


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Odontogenic Myxoma

Clinical FeaturesThese are painless, slow

growing which cause root

dilaceration and in some

cases root resorption

Generally associated with

retained or missing teeth

Causes cortical expansion and

eventual perforation, and results to

tumefaction and facial deformity


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Odontogenic Myxoma

Radiographic Features It may appear as a well-circumscribed or a

diffuse radiolucent lesion

Often, it is multiloculated and has a

honeycomb pattern


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Odontogenic Myxoma


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Odontogenic Myxoma

HistopathologyThis tumor is composed of bland, relatively

acellular myxomatous connective tissue

Benign fibroblasts and myofibroblasts with

variable amounts of collagen are found in amucopolysaccharide matrix

Odontogenic rests are absent


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Odontogenic Myxoma


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Odontogenic Myxoma


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Odontogenic Myxoma

Differential DiagnosisAmeloblastoma

Central Hemangioma

Giant Cell Granuloma


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Odontogenic Myxoma

Treatment and PrognosisSurgical excision

For small unilocular lesions enucleation

and curettage followed by chemical bone

cautery can be done

Prognosis is very good.


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CENTRAL

ODONTOGENIC

FIBROMA

Anne Celso


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CENTRAL ODONTOGENIC

FIBROMACLINICAL FEATURES

-benign odontogenic neoplasm occurring within the

jaws

-the lesion is central in bone and has persistent

progressive growth


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CENTRAL ODONTOGENIC

FIBROMA


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CENTRAL ODONTOGENIC

FIBROMA

CLINICAL FEATURES-more common in adults, with the average

age being 40.

-twice as likely to affect women than men

-usually found either in the anterior maxilla orthe posterior mandible


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CENTRAL ODONTOGENIC

FIBROMA

RADIOGRAPHIC APPEARANCE-appear as a loculated radiolucent area that

may be associated with unerupted or displaced teeth

-uni or multilocular radiolucency involving

periodontal and crestal bone adjacent to dental roots


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CENTRAL ODONTOGENIC

FIBROMA


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CENTRAL ODONTOGENIC

FIBROMA

MICROSCOPIC APPEARANCE-In the simple type, the lesion is composed of

a mass of mature fibrous tissue containing few

epithelial rests.

-In the World Health Organization type,

mature connective tissue contains abundant rests

and calcific deposits of what is regarded as dentin or

cementum.


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CENTRAL ODONTOGENIC

FIBROMA


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CENTRAL ODONTOGENIC

FIBROMA


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CENTRAL ODONTOGENIC

FIBROMA

DIFFERENTIAL DIAGNOSIS-Desmoplastic fibroma

-Fibromyxoma

-Hyperplastic follicular sac


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CENTRAL ODONTOGENIC

FIBROMA

TREATMENT-enucleation or excision

PROGNOSIS

-recurrence is very uncommon


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BenignCementoblastoma

Anne Celso


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BENIGN CEMENTOBLASTOMACLINICAL FEATURES

-aka true cementoma-benign neoplasm and forms a mass of

cementum-like tissue as an irregular or round massattached to the roots of a tooth

-often involving the mandibular molars or

premolars-involved tooth usually has a vital pulp

-usually occurs in people under the age of 25

-asymptomatic


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BENIGN CEMENTOBLASTOMA


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CLINICAL FEATURES-have unlimited growth potential

-behave in a locally aggressive manner

resulting in bony expansion, root resorption,

displacement of adjacent teeth, and jaw deformity

-higher predilection for males


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RADIOGRAPHIC APPEARANCE-appears as a well-defined, markedly

radiopaque mass, with a radiolucent peripheral

"line", which overlies and obliterates the tooth root

-there is usually apparent external resorption

of the root where the tumor and the root join.


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BENIGN CEMENTOBLASTOMARADIOGRAPHIC APPEARANCE


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MICROSCOPIC APPEARANCE-presents cementum-like tissue with

numerous reversal lines

-prominent basophilic reversal lines may give

a pagetoid appearance to the lesion


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DIFFERENTIAL DIAGNOSIS- Severe hypercementosis

-Chronic focal sclerosing osteomyelitis

-Cementoblasts

-Osteoblastoma


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TREATMENT-removal of the tumor, along with the affected

tooth and curettage or peripheral ostectomy

-enucleation of the tumor through

apicoectomy following root canal treatment


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PROGNOSIS-an excellent prognosis is usually achieved

after complete removal of the tumor.

-recurrence and continued growth are

possible if lesional tissues are left behind after initial

surgery


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CENTRALODONTOGENIC

FIBROMA

Zivar Chalaki


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Cementifying fibroma

Is a benign neoplasm of bone that has the potential for

excessive growth, bone destruction, and recurrence.it is

clinically and microscopically similar to ossifying fibroma.

Composed of a fibrous connective tissue stroma in which

new bone is formed, it is classified as one of the benign

fibroosseous lesion of the jaws.


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Etiology and pathogenesisIs of undetermined cause.

Although chromosome translocations have been identified in a

few cases of cementifying fibroma , genetic studies have been

insufficient to determine the molecular mechanisms that

underlie the development of this tumor.


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Clinical feature Uncommon lesion that tends to occur during 3rd and 4th

decades of life

In women more than men

Is a slow-growing, asymptomatic, and expansile lesion.

Maybe seen in the jaws and craniofacial bones

Lesion of the jaws characteristically arise in the tooth bearing regions


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Clinical feature Most often in the mandibular premolar ,molar area

The slow but persistent growth of the tumor may ultimately

produce expansion and thinning of the buccal and lingual

cortical plates, although perforation and mucosal ulceration

are rare.

The most important radiographic feature of this lesion is the

well_circumscribed, sharply defined border.


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Clinical feature

Cementifying fibroma, cementoossifying fibroma, and

psammomatoid ossifying fibroma are terms occasionally

used when the bony islands in these lesions are round or

spheroidal.

These tumors occur in similar age groups and locations,

exhibit comparable clinical characteristics, and have the

same biologic behavior.


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Histopathology Is composed of fibrous connective tissue with well

differentiated spindled fibroblast.

Cellularity is uniform but may vary from one lesion to the

next.

Collagen fibers are arranged haphazardly , although a

whorled, storiform pattern may be evident.


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Histo pathology Bony spheroids , trabeculae, or islands are evenly distributed

throughout the fibrous stroma.

Bone is immature and often surrounded by osteoblasts;

osteoclasts are infrequently seen.


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Treatment and prognosis Surgical removal using curettage or enucleation .

The lesion can typically be separated easily from the

surrounding normal bone.

Recurrence is described only rarely after removal.


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Treatment and prognosis


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Cemento-OsseousDysplasias

Mohsen Derakshanfard


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Cemento-Osseous Dysplasias

Includes

Periapical Cemental Dysplasia (PCD)

Florid cemento-osseous dysplasia (aka Florid

Osseous Dysplasia, FCOD, FOD)

Focal Cemento-osseous dysplasia (aka Focal

osseous dysplasia, FCOD, FOD)

This lesion appears to arise from the periodontal ligament and containsvarious amounts of fibrous tissue, cementum, and bone.

All of these lesions represent the same

histopathological process, but are distinguished

by the location and extent of lesions in the jaws.


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Radiographic featuresPCD is a localized change in bone metabolism. It occurs at the apices of lower

anterior teeth

This lesion passes through three stages in its maturation.

The osteolytic stage occurs first and is characterized by localized dental periapicalradiolucencies similar in appearance to those that occur with a dental abscess.

The next period is termed the cementoblastic stage. During this time cementoblastsbecome more active and produce spicules of cementum, which produce a mixed

radiolucent/radiopaque appearance.

The final or mature stage consists of an abnormally large amount of calcificationthat appears as a dense periapical radiopacity surrounded by a thin radiolucentborder.


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Radiographic Features

Location

Apices of mandibular anterior teeth

Multiple or solitary

Shape and Borders

Well defined Round, oval or irregular shape

May have a sclerotic border


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Periapical cemental dysplasia (earlystage)

Multiple radiolucencies at the apices of the mandibular anterior teeth.

In periapical cemental dysplasia, the teeth are vital unless otherwise

involved with caries or trauma.

The radiolucencies should not be misdiagnosed as inflammatory

apical lesions (granulomas, cysts, abscess) in which the teeth are

nonvital and maybe symptomatic.


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Periapical cemental dysplasia (early

stage)


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Periapical cementaldysplasia (earlystage).


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Periapical cemental dysplasia(calcified stage).

Each radiopacity is surrounded by a radiolucent border at the apices

of mandibular incisor teeth.


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Effects on adjacent structures

May efface the lamina dura of adjacent teeth

Root resorption is rare

Surrounding bone may become sclerotic

Occasionally, large lesions may cause

expansion of the jaws


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Periapical cemental dysplasia

(MATURE stage)


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Periapical Cemental Dysplasia

Clinical Features

Teeth are vital

Usually an incidental radiographic finding

F:M 9:1

3:1 African: Caucasian

Frequent in Asians Mean age = 39 yrs

In most cases, multiple lesions are present that are asymptomatic.


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DentinomaMohsen Derakshanfard


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Histologic description

This lesion contains varying amounts of fibrous connective

tissue, cementoblasts, and cemental tissue depending on the stage ofthe lesion.

Treatment

Periodic radiographic observation is appropriate. The teeth are vitaland should not be treated by extraction or endodontic therapy.Electrical, thermal, and mechanical stimulation of the teeth can aidthe clinician who is attempting to rule out dental infection duringthe osteolytic or cementoblastic stages.


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dentinomaThis type is quite rare, is composed of connective tissue,

odontogenic epithelium, and abnormal dentin associated

with coronary portions of unerupted permanent teeth. Its

radiographic appearance is radiopaque mass in close

proximity to the crown of an unerupted tooth.


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Clinical feature

Age and sex

it seen in px younger than 36 years with an average of age 26 years with no sex

predilection for occurrence

It is often associated with an impacted tooth;however, extraosseous cases can occur. Pain,

swelling, and mucosal perforation have been reported.

Site

it is predominately seen in mandible. especially in molar area and frequently is associatedwith an impacted tooth.

The tumor is located, usually in intraosseous structures, although there are reports that say

they have found in the soft tissues. Causes increased bone volume expansion. May or may

not be pain.

Symptomes

patient notices a swelling over a variable period of time with pain.

Sign

perforation of mucosa and subsequent infection may be present. There may be redness of

overlying mucosa with discharge.


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Radiographic featuresThe radiographic picture may be extremely variable. It may

appear as a radiolucency, a radiolucency with small radiopaqueflecks, or a solitary radiopaque mass.

Internal structure

the lesion offers a radiolucency, specific limits,withinwhich are irregular radiopaque mass that may vary in size andextension.

it contain either a large, solitary, opaque mass or numerous smallerirregular radiopaque masses of calcified material which may varyconsiderably in size

Bone

It may cause local destruction of bone.


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Histopathological featuresThe connective tissue stroma resembles dental papilla. Masses

of irregular Dentin(whichhas been termed as dentinoid or

osteodentine) with demonstrable dentinal tubules are present.

Undifferentiated odontogenic epitheliumis present and

enamel is absent. If enamel were present the lesion would be

called a complex composite odontoma.

Dentinoma. Histological section showing

a tumor composed mostlyof dentin dysplasia

,poorly calcified.


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Pathology

Microscopically, the dentinoma mayresemble ameloblastic fibroma.Epithelial tissue that composesit often takes the form of fine strands, consisting of roundor cuboidal cells are arranged in one or two layers. The

connective tissue resembles that of the dental papilla by thetype and degree of cellularity.

Among the connective tissue andodontogenic epithelium shows a poorly

organized dentin deposition which gives sometimes anaspect of osteodentin or interglobular dentin. Somecells, like odontoblasts-often present around the isletsof dentine. In the dentin frequentlypoorly mineralized mesenchymal cells can be seen inside.


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managementSurgical incision with through curettage of area and

enucleation .

A careful excision with removal of all tumor

formation, is sufficient for control. It should

be detailed in the eventual removal of fibrouscapsule, since at the expense of it, when

left remains, recurrence occurs, although this is unusual.

mesenchymal tumors

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